Narratives, texts and other resources: clinical reasoning and decision-making in oncology

Abstract

The article explores collaborative diagnostic decision-making processes in the field of oncology through the discursive analysis of spontaneous interactions between doctors, collected during their daily work practice in a hospital in central Italy. The results highlight the key role played by the narratives in supporting decision-making in cases of difficult diagnosis. Rather than addressing them as individual problems of a logical-deductive nature, physicians use an abductive, dialogical and narrative thinking, sharing knowledge and resources available in the hospital community.Different narrative formats are used in the effort of balancing the specificity of individual cases and the general indications of evidence-based medicine (reference to clinical trials, guidelines). Implications for the education of physicians and for organizational interventions are discussed in the conclusions.